宋维汉 符韶鹏 邱铁东 程鹏云 130021 长春， 白求恩医科大学基础医学院病理科(宋维汉、 邱铁东)； 病理科实习七年制医学生(符韶鹏)； 白求恩医科大学第三临床学院(程鹏云) 中华小儿外科杂志 1998 0 0 5


    关键词：胆道闭锁；新生儿肝炎；三维构形 期刊 zhxrwkzz 0 论 著 fur -->


    

摘要 目的：通过病理学方法， 作出肝外胆道闭锁的诊断和预后判定。方法： 对23例婴儿阻塞性胆管病和5例对照的肝组织，按病理诊断和年龄分组，进行肝组织的二维病理学研究和肝内胆管三维构形观察。结果：肝外胆道闭锁与狭窄和新生儿肝炎肝组织的病变相似，仅程度不同。不同年龄组间， 胆管增生、汇管区面积和肝纤维化及肝硬化有显著性差异。胆道闭锁的大月龄组中胆道病变和胆栓明显，新生儿肝炎时肝细胞坏死更突出。肝内胆管的三维构形表明，胆道闭锁时增生赫令管多数管腔开放， 并互相连接成网络状；少数赫令管形成膨大盲端和局部小叶间胆管形成微囊肿。结论：①阻塞性胆管病时， 肝纤维化、胆管增生和汇管区面积与患儿月龄有关；②赫令管形成网络状暗示胆道阻塞，结合胆管的病变和胆栓有助于诊断胆道闭锁；③胆管的微囊肿和赫令管膨大盲端提示胆道闭锁预后差。

    A Pathological Study of Obstructive Jaundice inInfants Song Weihan, Fu Shaopeng, QiuTiedong et al. Dept. of Pathology. The School of Medical Science. Changchun 130021

    Abstract Objective: The aim of this study is to establish the diagnosis andevaluate the prognosis of extrahepatic biliary atresia with histopathology. Methods: Livertissues of 23 patients with obstructive jaundice and 5 normal controls were studied. The 2dimensional and 3 dimensional patterns of bile ducts were reconstructed withcomputer-aided graphics. Results: The pathological changes in liver were similar amongextrahepatic biliary atresia, extrahepatic biliary stenosis and neonatal hepatitis, butthe degree of changes varied. The degrees of ductal proliferation and liver cirrhosisaround porta hepatis differed among the children of different age groups. Pathologicalchanges of bile ducts and bile plugs were prominent in infants more than 3 months of agewith biliary atresia. Hepatocyte necrosis was more prominent in children with neonatalhepatitis. Three dimensional study of intrahepatic bile ducts showed that theproliferating ducts (Herring's canals) were mostly patent and formed interconnectednetwork. Occasionally, Herring's canals terminated blindly or with cysts formation.Conclusions: There is a positive correlation between age, the severity of cirrhosis andductal proliferation. Network formation of Herring's canals suggests biliary obstruction.This, together with ductal change and bile plug, contributes to the diagnosis of biliary atresia. Blind end or cyst formation of Herring's canals predicts poor prognosis.

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